"My family won't let me." Adolescent-reported barriers to accessing mental health care.

Depression is the leading cause of disability among adolescents. Fewer than 50% of youth with depression access mental healthcare services. Leveraging a mixed-methods approach, this pre-registered study characterized youths' self-reported barriers to accessing mental healthcare in a socio-demographically diverse sample of 123 United States adolescents (ages 13-16, identifying as Asian (n = 19), Hispanic (n = 23), Black (n = 7), White (n = 65), or other race (n = 9); man (n = 9), woman (n = 58), or gender minority (n = 56); heterosexual (n = 19) or sexual orientation minority (n = 104)). All participants were experiencing elevated depression symptoms (Patient Health Questionnaire-2 score of ≥2) and endorsed wanting mental health support but being unable to access it. We asked participants an open-ended question gauging perceived barriers to accessing care ("what has kept you from getting support when you wanted it?"), and a binary item gauging perceived current need for mental health support ("right now, do you feel that you need support for emotional or mental health problems?"). Via thematic analysis of responses to the perceived barriers question, we identified a total of 13 categories of barriers. Across all participants, 42.48% (n = 52) endorsed family-related barriers and 31.71% (n = 39) endorsed financerelated concerns. We conducted Chi-square analyses, examining rates of endorsing specific barriers as a function of (a) perceived current support need and (b) demographic variables (e.g. race/ethnicity, gender). In the current study, all adolescents endorsed similar categories of treatment access barriers, regardless of race/ethnicity, gender, sexual orientation, and level of depression. Implications for increasing mental healthcare access for adolescents with elevated depression symptoms are discussed.